Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure... Show moreCardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and all-cause mortality. Nevertheless, up to two-thirds of eligible patients are not referred for CRT. Furthermore, post-implantation follow-up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three European Society of Cardiology Associations, Heart Failure Association (HFA), European Heart Rhythm Association (EHRA) and European Association of Cardiovascular Imaging (EACVI), focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post-procedural care by focusing on four actionable domains: (i) overcoming CRT under-utilization, (ii) better understanding of pre-implant characteristics, (iii) abandoning the term 'non-response' and replacing this by the concept of disease modification, and (iv) implementing a dedicated post-implant CRT care pathway. Show less
The essence of VBHC is to improve patients' outcomes at lower costs. This thesis attempts to construct the value quotient (vQ) for IBD: a metric for value which incorporates patient value, defined... Show moreThe essence of VBHC is to improve patients' outcomes at lower costs. This thesis attempts to construct the value quotient (vQ) for IBD: a metric for value which incorporates patient value, defined as a combination of disease control, quality of life, and productivity in the numerator, and divides it by the associated IBD-related costs in the denominator. In this thesis we showed the feasibility of monitoring clinical disease control remotely using a mobile app, we showed the impact of IBD on work productivity, and we developed a patient-centric composite score that incorporates all three outcomes as well as individual patient preferences. However, metrics for long term outcomes still need to be incorporated in the vQ. Although ideally this would be done by measuring disease outcomes long-term, this is not practical for short-term improvements. Process measures that are associated with long term outcomes and that are well-grounded in the medical literature offer a feasible short term alternative. Future research is needed to assess which process measures would be appropriate in this context, and to develop a quantifiable way to include these in the vQ. Show less
